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A Week in My Dental Practice

"I have gained a bit of a reputation for dealing with patients who have a phobia." Dr. Anne Twomey, dentist in Carrigaline, Co Cork.

Before I go into work, I check my emails. If I’ve had a patient who has had a surgical procedure the day before, I’d often text them or give them a ring to make sure they’re all right. I might tell them to come into the practice. It rarely happens, but it’s backup and it puts my mind at rest.

Partnership

I am in partnership with two other dentists in a practice in Carrigaline, Cork and when I get to work I have a short meeting with the staff, looking at who’s coming in and whether there’s anything I should know about them.

They might have phoned ahead to say they’re particularly nervous or there might be a financial issue, meaning they can’t afford all the treatment they’re down for, but they might be able to afford some of it. After the briefing, I plough through my day. I generally have people coming in every half an hour for appointments but there’s flexibility within that.

Some people might need an hour or an hour and a half. I try to anticipate problems. I always break for lunch at 1pm. I need to get out of the room because my work is very intense. I go for a walk and go to lunch, often on my own. I might read a newspaper and, now that I’m president of the Irish Dental Association, I tend to have a lot of emails and phone calls to return.

My mother was a dental nurse before she married so there was always an interest in all things dental when I was growing up.

Phobias

I have gained a bit of a reputation for dealing with patients who have phobia. It’s normal to be a little bit nervous going into a dentist. But for some extremely nervous patients, their fear might be a barrier to getting things sorted. They might have been putting up with a toothache for a while.

That has to be addressed in a real fashion. Sometimes, just talking to the patient can put their mind at rest. For some, it’s a control thing and if you explain what you’re going to do, it can help. But if it’s the case that a person doesn’t sleep the night before a dental appointment and gets physically sick, I will often give them a relaxing drug to take the night before or an hour before coming into me. I’ve introduced inhalation sedation to the practice. It’s the old-fashioned “happy gas” or “laughing gas”, known as nitrous oxide, that was very popular in the 1960s and 1970s. It’s still huge in the US, particularly for children. It’s sometimes called conscious sedation and I’d use it if something inherently unpleasant has to be done on a very nervous person.

The patient is awake but is so chilled out and compliant that they’re amenable to treatment. I use inhalation sedation about once a day, although sometimes I might use it three times a day. It’s for long appointments, and when I’m using it, it’s best to get through several things at once. I’m not going to stop at just one filling. I’ll do whatever is needed at the session. Typically, after treatment, the patient comes round within 10 minutes, and sometimes it’s even quicker.

Traumas

No two days are alike. On a recent Friday, a little girl came in. She had fallen in a playground and had smashed half of a front tooth. She spent the whole day in hospital, but was told they couldn’t fix the tooth, so the hospital rang me and I stayed on late and treated her. Children and traumas are a big thing. All patients have my mobile number in case of an emergency. But I can count on one hand the number of times I was phoned out of hours. I provide a service until 7pm on Mondays. That’s for people who can’t get out of work to see me during the day.

Also, I work every second Saturday until 1pm although I try to stop that for the summer, because people cancel appointments when the weather is good.

Geriatric dentistry

On my half-day on Thursdays, I visit nursing homes and the homes of elderly patients. I have a masters in geriatric dentistry. It’s not a moneyspinner, and I suppose I was naive in thinking that Ireland was ready for it. It’s a totally neglected area. I treat elderly people in a very palliative way. It’s about pain relief and getting people comfortable.

I see it as my charity work. I claim what I can from the medical cards but there’s no funding for house calls. What I find most stressful is dealing with the business end of things and managing staff. I didn’t fill out my CAO years ago to be a business person. I have been practising for 22 years and it never struck me that I’d be self-employed and running a business. Nor did I ever think I’d be in charge of an association.

I just fit in my work for the Irish Dental Association. If I have a gap in the day because a patient has cancelled, that’s half an hour in which I can write if I have a speech to make. I also deal with letters from oncologists, orthopaedic surgeons and cardiologists about whether it’s okay to go ahead with a treatment. I’m very efficient and I tend not to bring work home.

That’s the rule in our house. My husband, John Holland, is also a dentist and he is in a different practice. I don’t think we talk shop all the time, although my kids think we do. We have very different skills and are very respectful of each other. Keeping up with developments in dentistry is constant. I’m in a very privileged situation through being involved in the Irish Dental Association. I’m on top of what’s current. There’s a constant drip feed all the time. You don’t feel you’re learning but I’m picking up new information all the time.

Annual conference

In November I will be going to Washington for the annual conference of the American Dental Association. It’s huge; people come from all over the world to it. It’s an expensive thing to do but I’m representing the Irish Dental Association there this year and I have the added value that my husband is also going. So we get to go away together and talk about teeth. It’s brilliant to go to the US and see how they do dentistry. Having said that, when I was in Chicago last year, I was expecting to be blown away by dental science. But we’re every bit as good here in Ireland as in the US.